Gastric adenocarcinoma remains a prominent global cause of mortality and ranks as the 16th most prevalent cancer in the UK. Key stages in its progression, namely gastric atrophy (GA) and gastric intestinal metaplasia (GIM), collectively known as chronic atrophic gastritis (CAG), are often attributed to Helicobacter pylori infection or, less commonly, autoimmune gastritis. The British Society of Gastroenterology advocates for biopsy confirmation in patients exhibiting image-enhanced features of CAG, directing biopsies to Sydney protocol areas where GIM is disclosed. Our study aims to assess the CAG detection rate, compliance with BSG guidelines, and follow-up adherence in patients undergoing upper GI endoscopy at SRFT for upper GI symptoms, with the goal of proposing practice improvements.

Patient data from the Electronic Patient Record (EPR) was analyzed against inclusion criteria. Endoscopy reports documented patient complaints, CAG identification, endoscopic classification, and biopsy adherence to the Sydney protocol. Histopathology reports and clinical letters were scrutinized for CAG confirmation and surveillance plans.

The study revealed a low CAG detection rate of 5%, contrasting with the national prevalence of 10%. Compliance to the Sydney protocol for biopsies was at 0%, raising concerns about potential missed or misdiagnosed cases due to insufficient risk assessment. Moreover, compliance with mapping biopsies, follow-up protocols, and high-risk CAG surveillance was also at 0% or suboptimal (2.5%).

The observed low CAG detection rate suggests that endoscopists may not highly suspect this condition. Non-compliance with the Sydney protocol for biopsies raises concerns about diagnostic accuracy, highlighting the need for mapping biopsies. Lack of follow-up at 3 years underscores the importance of improved compliance to enhance early detection of gastric adenocarcinoma, aligning with the overarching goal of reducing associated mortality rates.